Provider Demographics
NPI:1518575778
Name:EYE SURGERY OF THE MAIN LINE, LLC
Entity Type:Organization
Organization Name:EYE SURGERY OF THE MAIN LINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHAIR, VALUEHEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSET
Authorized Official - Suffix:
Authorized Official - Credentials:MEMBER
Authorized Official - Phone:913-387-0510
Mailing Address - Street 1:11221 ROE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1941
Mailing Address - Country:US
Mailing Address - Phone:913-387-0510
Mailing Address - Fax:913-685-2208
Practice Address - Street 1:333 E CITY AVENUE
Practice Address - Street 2:TWO BALA PLAZA
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-668-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical